| NPI | 1982966404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 59036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R - 9364) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2016-01-15 |